Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I) Access to Radiology Information (ARI) Retrieve Information for Display (RID)

Distributing Images: Cross-enterprise Document Sharing

for Imaging (XDS-I) Access to Radiology Information (ARI)Retrieve Information for Display (RID)

Rita Noumeir, Ph.D. Rita Noumeir, Ph.D. Professor

University of Quebec

• Sharing of Imaging Information across health enterprises

• Imaging Information includes – extensive sets of DICOM instances

including images, evidence documents and presentation states

– diagnostic reports provided in a "for display" form

– selection of diagnostically significant images associated with the report content

Abstract / Scope

Radiology Enterprise A

Radiology Enterprise B

Physician Office

Regional Health Regional Health Information Information NetworkNetwork

PACS B

PACS A

Radiology-to-radiology

Radiology-to-Physicians

Sharing Radiology Reports and Imagesin a Regional Health Information Network



Physician Office


Cross-Cross-Enterprise Enterprise RegistryRegistry

Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B• Report 2/18/2005 : Chest Xray A• Study 2/18/2005 : Chest Xray A

PACS B

PACS A

Sharing Radiology Reports and Imagesin a Regional Health Information Network



Physician Office


Query for Query for Documents Documents

Register Imaging Register Imaging Information for Information for

sharingsharing

Priorimaging

Reports & Studies


Register Imaging Register Imaging Information for Information for sharingsharing

Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B

Physicians and Systems within a Regional Health Network - Routine Imaging Referral



Physician Office


Register Imaging Register Imaging Information for Information for

sharingsharing


Notification of Notification of Doc AvailabilityDoc Availability

Register Imaging Register Imaging Information for Information for sharingsharing

Physicians and Systems within a Regional Health Network - Routine Imaging Referral



Physician Office

Prior Imaging Report & Study


Query for Query for documents documents

Imaging Report Imaging Report & Study& Study


Patient Id= 3547F45• Report 5/21/1998 : CT Head B• Study 5/21/1998 : CT Head B• Report 2/18/2005 : Chest Xray A• Study 2/18/2005 : Chest Xray A

Notification of Notification of Doc AvailabilityDoc Availability

Physicians and Systems within a Regional Health Network for a Routine Imaging Referral

Value proposition

• Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc.

• Effective means to contribute and access imaging documents across health enterprises. – Without XDS-I, access to the radiology report across health

enterprises is difficult

• Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems.

• Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest – with the same mechanisms used to query other documents

Value proposition

• Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images remain in the source/Image Manager.

• Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain.

• Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report)

• Document Content Neutral: Document content is processed only by source and consumer IT systems.

• Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.

XDS-I Dependencies

• XDS-I depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS)

• New Actors– Imaging Document Source– Imaging Document Consumer (should be grouped with

Document Consumer)

• Same Actors as in XDS– Document Consumer– Document Registry– Document Repository

• Added extension to support imaging data (images and reports)

Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Imaging Document Source

Document Registry

Document Repository

Provide & Register Document Set

Register Document Set

Imaging Document Consumer

Retrieve Images

Retrieve Presentation StatesRetrieve Key Image NoteRetrieve Evidence DocumentsWADO Retrieve

XDS-I Actors and Transactions

XDS-I New Transaction requirements

• XDS-I Actors:– Imaging Document Consumer

• at least one Retrieve ( [RAD-55], [RAD-16], [RAD-17], [RAD-27], [RAD-31] [RAD-35])

– Imaging Document Source• Provide and Register Document Set [RAD-54]• WADO Retrieve [RAD-55]• Retrieve Images [RAD-16], Retrieve Presentation States [RAD-17]

Retrieve Reports [RAD-27], Retrieve Key Image Note [RAD-31], Retrieve Evidence Documents [RAD-45]

• XDS Actors– Document Repository

• Provide and Register Document Set [RAD-54]

Options

• Imaging Document Source must support at least one of the following options:– Extensive Set of DICOM Instances – PDF Report – NEW Text Report wrapped in a CDA Document

– NO Text option– NO multipart Text / PDF option

Sharing of Extensive DICOM Instance Set

Document Registry

Document Repository

Manifest

Reference to image 1

DICOM Manifest


Reference to image 3Manifest Manifest

Clinical Encounter

Clinical IT System

Query Registry

Manifest

Retrieve Manifest


DICOM Manifest



Retrieve Images

Register Manifest

Manifest

Sharing of Extensive DICOM Instance Set

• The shared Document is a manifest – a Key Object Selection DICOM Instance

• title : manifest

• Imaging Document Source is required – to ensure that the referenced images from within

a published manifest are available to be retrieved• Imaging Document Source is responsible

– for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change of the DICOM SOP instances referenced within the manifest)

Sharing of Imaging Report

Radiology systemReport Source

…..

Findings:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Text wrapped into CDA Report

PDF Report


Document Registry

Document Repository

Report Report

Clinical Encounter

Clinical IT System

Query Registry

Retrieve Report

Register Report

Report

…..

Findings:

Header:


BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Sharing of Reports

• The shared Report Document format is – PDF, Text wrapped in a CDA

• A report can – embed selected images in its PDF format – include fully resolved hyperlinks (interactively clickable)

that point to the selected images• Imaging Document Source is responsible

– for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document

• Imaging Document Source is required – to ensure that image references are valid links

XDS-I Actors / Grouping

• No specific grouping requirement on Imaging Document Source, however:– Imaging Document Source is responsible of

ensuring published images in a manifest are available to be retrieved

• Imaging Document Consumer shall be grouped with a Document Consumer

Linking Report to Complete Set of Images

Document RepositoryDocument Repository

Document RegistryDocument Registry

Study

Manifest

Report

DocumentEntry

DocumentEntry

SubmissionSet

Linking Report to Complete Set of Images



DocumentEntry

SubmissionSet 1

Report

DocumentEntry

SubmissionSet 2

Study

Manifest

Linking Report to Prior Images and Prior Report



DocumentEntry

SubmissionSet 3

Prior Study

Manifest

DocumentEntry

SubmissionSet 1

Prior

Report

DocumentEntry

SubmissionSet 2

Report

DocumentEntry

SubmissionSet 4

Study

Manifest

Linking Report to Selected Images


…..

Findings:

Header:


BPD ...…..

Radiology Report

Relevant Image

GestationalAge

...WADO URI

Link to image

XDS-I Metadata

• Radiology specific– Acquisition Modality (e.g. CT, MR)– Anatomic Region (e.g. Arm, Elbow, Hand)– Requested procedure (e.g. MRI Knee with

contrast)

• Query example – find all “CT of the Head” of patient John Doe

for the last 2 years

Access to Radiology Information

Access to Radiology InformationAbstract /Scope

• Provides access to radiology information within the rest of the hospital (e.g., ER, OR, cardiology, oncology, etc)– Images, evidence documents, presentation states, key

image notes, structured radiology reports • Query and retrieve based model

• Multiple Sources Option– Allows user access to distributed Radiology information– One user’s action, queries to multiple sources,

consolidation of results.

Access to Radiology Information constraints

• DICOM Query/ Retrieve– Defines Matching keys for response filtering

by Image Manager/Archive– Defines Return keys to be requested by Image

Display– Defines Returned attributes supported by

Image Manager/Archive in query responses– Defines Returned attributes required to be

displayed on Image Display

Retrieve Information for Display

Display

InformationSource

Retrieve Specific Info for Display [11]

Summary of Laboratory Reports

Summary of Radiology ReportsSummary of Cardiology ReportsSummary of Surgery ReportsSummary of Intensive Care ReportsSummary of Emergency ReportsSummary of Discharge ReportsList of AllergiesList of Medications

Retrieve Document for Display [12]

Persistent Document

Types ofRequests

Summary of All Reports

Summary of Prescriptions

Retrieve Information for display

Standards: HTTP, Web Service

XHTML, PDF, JPEG, CDA

Query Keys – Transaction [11]Retrieve Specific Information for Display

Parameter Name

RequestType

patientID

lowerDateTime

upperDateTime

MostRecentResults

REQ

R

R

O

O

R

Description

requestType specifies what type of information shall be retrieved. This parameter shall always be valued.

This attribute identifies the subject of the results being queried for. Its value shall include identification of assigning authority.

Used to constrain the earliest date/time of creation of information.

Used to constrain the latest date/time of creation of information.

The numeric value that indicates the number of most recent results to be included into the response, i.e., 1 indicates to provide the latest result.

Query Keys – Transaction [12]Retrieve Document for Display

Parameter Name

RequestType

DocumentUID

Description

This parameter is required to have a value of “DOCUMENT”.

Identifies document’s UID as known to both actors.

REQ

R

R

PreferredContentType

This parameter is required to identify the preferred format: JPEG. PDF, CDA L1 that the document is to be provided (as MIME content type).

R